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8110 Gatehouse Road, Falls Church, VA 22042

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RN Case Manager II

2740 Prosperity 618562 Full Time 2740 Prosperity Avenue, Fairfax, VA, 22031, US
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Job Description

As a Registered Nurse (RN) Case Manager II, you will actively participate in clinical performance improvement activities. To help achieve our mission, you will develop, implement and evaluate patient care plans and progression throughout the continuum of care or disease state. Working collaboratively in communication with physicians, nurses and other members of the multidisciplinary care team to effect timely and appropriate patient management is of vital importance. Your ability to provide discharge planning and continuity of care for assigned patients in the acute and post-acute setting with an understanding of pre-acute and post-acute resources is essential. Providing coordination of services and acting as a key Liaison between patients, families and interdisciplinary healthcare members is required.

Job Responsibilities
 
  • Collects quality metrics data for specific performance and/or outcome indicators.
  • Assists in the collection and reporting of resource/financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
  • Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team.
  • Uses concurrent variance data to drive practice changes and positively impact outcomes.
  • Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g. discharge planning, chronic disease planning).
  • Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
  • Ensures safe care to patients by adhering to policies, procedures and standards within budgetary specifications including time management, supply management, productivity and accuracy of practice.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competencies. Supports department based goals which contribute to the success of the organization.
  • Participates in the assessment of patients' clinical and psycho social needs through review of patient information, personal contact with patients/families and interdisciplinary healthcare team members.
  • Communicates routinely with patients, families, interdisciplinary healthcare team members and other appropriate parties with regard to the status of patients' care plans and progress toward treatment goals, identification of concerns/problems, problem solving and assisting with conflict resolution when necessary.
  • Addresses/resolves system problems impeding diagnostic or treatment progress.
  • Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
  • Ensures that all elements critical to patients' care plans have been communicated to patients/families and members of the healthcare team and are documented as necessary to ensure continuity of care.
  • Provides discharge planning and continuity of care for assigned patients in the acute and post-acute setting. Initiates and facilitates referrals to specialists, clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated.
  • Collaborates with interdisciplinary healthcare teams, patients and families in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs, delivery of post-discharge services and transition of patients from the hospital to the discharge setting in addition to ongoing care in the community.
  • Documents relevant discharge planning and/or care management plan information in medical records according to department standards and/or care management plan.
  • Collaborates/communicates with internal and external Case Managers. Demonstrates an understanding pre-acute and post-acute resources.
  • Works closely with members of patients' healthcare teams to manage and coordinate all areas of patients' care.
  • Works holistically to ensure that care plans and discharge plans meet the physical, social and emotional needs of patients.
  • Provides educational resources and/or referrals to patients/families to address identified needs such as social or financial needs.
  • Acts as an advocate for patients to resolve barriers to care progression.
  • Communicates with payers or required parties to ensure reimbursement certification for assigned patients.
  • Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed.
  • Applies approved clinical criteria to monitor appropriateness of admissions, continued stays or post-acute/ambulatory setting appropriateness and documents findings based on department standards.
  • Identifies at risk populations using approved screening tools and follows established reporting procedures.
  • Monitors LOS and ancillary resource use, depending on inpatient stay or outpatient program criteria, on an ongoing basis and takes action to achieve continuous improvement efficiencies in both areas.
  • Refers cases and issues appropriately to resolve barriers to care progression.



Requirements

Education:

  • BSN

Experience:

  • 2 years of case management or clinical experience

License:

  • Active RN License in Virginia

Certification:

  • ACM or CCM or MCG
  • BLS from American Heart Association